Recommendations for training psychiatry residents in psychosomatic medicine.

BACKGROUND: The Accreditation Council of Graduate Medical Education (ACGME) mandates that residents in psychiatry training programs learn to provide psychiatric consultation to other medical and surgical services. The ACGME, however, offers little information to instruct academic faculty and institutions to what constitutes a quality educational experience in psychosomatic medicine/consultation-liaison psychiatry for the resident trainee. METHODS: These recommendations were developed through a collaborative process between educators in C-L psychiatry and members of the Academy of Psychosomatic Medicine's Residency Education Subcommittee. RESULTS: This manuscript provides a broad framework for what constitutes a well-rounded clinical and academic resident rotation on psychiatric consultation-liaison services. A rotation that is viewed positively by residents is important as it likely provides a foundation for a growing interest in Psychosomatic Medicine and the development of future fellows and subspecialty trained physicians.

The state of the service: a survey of psychiatry resident education in psychosomatic medicine.

BACKGROUND: Although required by the Accreditation Council for Graduate Medical Education, training of general psychiatry residents in Psychosomatic Medicine (PM) varies significantly between programs. In 1996, the Academy of Psychosomatic Medicine (APM) developed guidelines for residency training in PM. Since then, there has been no assessment of the status of PM training during psychiatry residency. OBJECTIVE: Assessment of the current state of PM training in U.S. psychiatry residency programs. METHOD: A 46-item questionnaire was sent via e-mail to 206 residency directors. Four major areas were assessed: the timing and duration of the PM rotation, level of faculty supervision, didactic curriculum, and role (or potential role) of the APM in residency education. RESULTS: Ninety-two surveys were returned (response rate 45%). Forty-four (54%) of the general psychiatry residencies reported the total duration of the C-L rotation as being between 3 and 6 months (including both full- and part-time rotation). Only 38 (46%) programs' residents complete their PM experience in 1 year of residency. The average Full-Time Equivalent of teaching faculty per service was 1.74 (standard deviation 0.92). Sixty-four (77%) programs have a formal didactic curriculum in C-L. Eighty-one (98%) respondents were aware of the APM. Fifty-eight (70%) had APM members among faculty. The most popular responses on how the APM could best serve training programs were the creation of a subspecialty curriculum (73%) as well as the development of a competency-based evaluation tool (66%). CONCLUSIONS: There is significant variation in how residents are taught PM during their training. The APM is a well-recognized organization that may define what constitutes adequate residency training in PM and may help programs fulfill the educational needs of residents.

Neuropsychiatric illness in systemic lupus erythematosus: insights from a patient with erotomania and Geschwind's Syndrome.

Individuals suffering from systemic lupus erythematosus (SLE) can develop a number of psychiatric conditions, including psychosis. It is often unclear in SLE patients with psychiatric illness whether their illness is primary, due to SLE brain disease, and/or due to treatments for SLE. This article describes a patient with SLE who developed erotomania and personality changes. The differential diagnosis and possible pathogenesis of psychiatric illnesses occurring in SLE patients are discussed.

Use of a portable tower and remote-controlled launcher to improve physical conditioning in a rehabilitating wild mallard (Anas platyrhynchos).

Prerelease reconditioning improves the chance of survival of rehabilitating raptors. Reconditioning may also help to rehabilitate waterfowl, including those that are threatened or endangered, especially if the birds are released during periods of migration. A flying harness, creance, remote-controlled launcher, and portable tower were used to create a means of reconditioning a rehabilitating 5-month-old female wild mallard duck (Anas platyrhynchos) that had been housed in a rehabilitation center for 7 weeks while recovering from an injury. Pre- and postflight serum lactate levels, body condition index scores, and controlled flight distances were used to assess the bird's degree of conditioning. Postflight serum lactate levels never returned to preflight levels and were not deemed a reliable indicator of physical fitness. However, the mallard showed an increase in endurance and strength as well as improved body condition index scores over the course of the reconditioning program.

A basic decision-making approach to common ethical issues in consultation-liaison psychiatry.

Ethical dilemmas are found throughout the daily work of C-L psychiatrists. Unfortunately, most psychiatrists have no more training in ethics than their nonpsychiatric colleagues. Psychiatric consults spurred by ethical dilemmas can provoke anxiety in psychiatrists and leave anxious colleagues without the clear recommendations they seek. C-L psychiatrists, and probably all psychiatrists, need more training in clinical ethics. C-L psychiatrists do not need to become clinical ethicists, but competence in handling the ethical issues most commonly seen in C-L work is needed. The 2008 ABPN guidelines for specialists in psychosomatic medicine mention specific ethics topics important in C-L work, and ways of attaining competence in these areas have been discussed in the C-L literature. The four cases discussed here illustrate the high level of complexity often seen in situations in which ethical dilemmas arise in C-L psychiatry. Given the sometimes furious pace of hospital work, it can be easy for C-L psychiatrists to be seduced by the idea of the quick, focused consult that simply responds to a simple question with a simple answer. Because cases involving ethical dilemmas often involve multiple stakeholders, each with his or her own set of concerns, a brief consult focused only on the patient often leads to errors of omission. A wider approach, such as that suggested by the Four Topics Method, is needed to successfully negotiate ethical dilemmas. Busy C-L psychiatry services may struggle at first to find the time to do the type of global evaluations discussed here, but increasing familiarity with approaches such as the Four Topics Method should lead to quicker ways of gathering and processing the needed information.

Antiemetics, akathisia, and pregnancy.

Gastrointestinal disorders are common in pregnant women. These disorders are often treated with antiemetic medications that block central dopaminergic neurotransmission. Dopamine antagonists can cause akathisia. Hormonal changes and other factors may place pregnant women at increased risk for the development of severe antiemetic-induced akathisia. The mental symptoms that can accompany akathisia can be misinterpreted as primary mental illness. The author reports on the case of a pregnant woman who attempted to injure herself after developing severe antiemetic-induced akathisia.